Forensic and Mental Health C83FMH Lecture 2: Interventions for offending behaviour Dr Ellen Townsend NB. You do not have all my slides on handouts: make notes!

Aims To evaluate whether interventions designed to rehabilitate offenders are effective To explore this question using an ‘evidence-based’ approach

Punishment or rehabilitation ? Should we try to rehabilitate young offenders or should we just punish them? If rehabilitation –what should this involve –how should it be done –by whom and where ? Consider –Risk factors for offending? –Age? –Gender? Risk factors include - Troubled home life Peer-group pressure Poor attainment at school Drug and alcohol use or mental illness Deprivation

What should we do about young offenders? 'Prison not working' for young offenders Matt Weaver Monday May 8, 2006 Guardian Unlimited Guardian Unlimited Guardian Unlimited ‘Government's young offender scheme fails’ Daily Mail 27th October 2005

Punishment and rehabilitation The Youth Justice Board (YJB) The YJB oversees the youth justice system in England and Wales. Prevent offending and re-offending by children and young people < 18 Prevent offending and re-offending by children and young people < 18

Youth justice facts in England and Wales A child can be responsible for criminal behaviour in the England and Wales at age to 17 year-olds in prison - more than doubled in last ten years

What happens to them? YOTS (Youth Offending Team) community orders e.g. Intensive Supervision and Surveillance Programme (ISSP) and intensive fostering. Custody –LASCH (Local Authority Secure Children’s Home) –YOI –Secure Training Centres.

Interventions for offending behaviour Family and parenting interventions Multisystemic treatment Cognitive behavioural interventions Tackle re-offending and anti-social behaviour Lack of randomized studies (eg. Farrington, 2003) Effectiveness uncertain Evidence-based approach required?

What is the best evidence? Observational study without control groups e.g. Cross-sectional study? Expert opinion? Experimental study without randomisation? E.g. Case control Experimental study with random allocation e.g. RCT?

Evidence-based practice Use of current best evidence in making decisions about practice (eg. healthcare) Systematic reviews of evidence Steps involved Hierarchy of study designs (Highest quality first) 1. Experimental studies (RCT with concealed allocation). 2. Experimental study without randomisation Observational study with control group Cohort study Case control 3.Observational study without control groups Cross-sectional study Before-and-after study Case series 4.Expert opinion or consensus; Case reports Study quality: design, conduct and analysis minimize bias. Source: Khan et al (2003)

Bias eg. 1: Transcutaneous nerve stimulation for post-operative pain relief

Methodological issue Exaggeration of odds ratio (%) Inadequate allocation (e.g. alternation) Larger by 41% Unclear treatment allocation Larger by 30% Trials not double blind Larger by 17% Bias eg. 2 : Methodological quality and estimates of treatment effects in controlled trials (Schulz et al 1995) Trials were compared with those with adequately concealed treatment allocation

Deciphering the allocation concealment scheme (Lancet, 2002)

Evidence for offending and antisocial behaviour: multisystemic therapy (MST) One of few empirically supported interventions Widely disseminated USA and Europe Strong research base with multiple randomised controlled trials MST: –Multifaceted, short term, community-based –Social and family systems theories and causes/correlates of antisocial behaviour –Manual-based –Time-limited –Professional mental health therapists deliver –Small caseloads –Intervention strategies integrated –USA

Main goals of MST Reduce –criminal activity in young people –antisocial behavior such as drug abuse and sexual offending Financial –decreasing rates of incarceration and out-of- home placements

Needs of young offenders and families Improve –parents discipline practices –family-community relations –school/vocational performance Increase –family affection –association with pro-social peers Decrease –association with deviant peers Engage in positive recreational activities Empower family to solve future difficulties

Nine MST Treatment Principles. 1. Finding the Fit Positive & Strength Focused Increasing Responsibility Present-focused, action-oriented & well- defined Targeting Sequences

Nine MST Treatment Principles… 6. Developmentally Appropriate. 7. Continuous Effort. 8. Evaluation & Accountability. 9.Generalization.

Missouri Delinquency Project (Bourdain et al)

MST Effectiveness 1: meta-analysis Curtis et al (2004) meta-analysis. Henggeler (2004) comments on Curtis. See reading list for references.

MST effectiveness 2: Systematic review Littell, Popa & Forsythe (2005) systematic review*. Littell (2005). Lessons from a systematic review of MST. Henggeler (2006) response. Littell (2006) See reading list for references – Littell et al (2005) see* * Cochrane Library: available via e-library gateway

Other interventions Family and parenting (see Sukhodolsky and Ruchkin, 2006). CBT (Felizer et al 2004). –Armelius and Andreassen (2007) Find published effectiveness studies yourself. *PDFs of papers in FMH practicals folder on Spsych

Quality assessment/critical appraisal See the Consolidated Standards of Reporting Trials (CONSORT) statement. A checklist that authors of trials should use when writing up results. Useful quality assessment/critiquing tool. Reference: Moher et al (2001). The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials. The Lancet, 357, Available via e-library gateway.

Summary A number of types of intervention have been tested with young offenders Experimental (randomized) evidence-base is lacking Some interventions are promising (eg. MST) but results are equivocal. Seek out effectiveness evidence for CBT and family interventions.

Video case studies As you watch the video case studies make a note of the risk factors for –Offending –Mental health problems in offenders Protective factors? Implications for intervention? Interventions tried? Discussion at end